The Spastic Colon
When someone says that he has problems expressing himself properly, one seldom thinks of his bowel function being the part having difficulty expressing what he is inwardly concerned with. Yet it makes sense to take what the speaker says literally [translator's note: the Dutch word for "express" means also "have a bowel movement"] and, as his physician, to enquire about his metabolism. Not infrequently the patient proves to be afflicted, to a greater or lesser extent, with a spastic colon problem. In the course of this account it will become clear what the connection is between the large intestine and someone's ability to put his ideas across.
There follows a description of the clinical picture as it is usually presented.(1)
The spastic colon (irritable bowel syndrome, colitis mucosa, emotional diarrhea) is a chronic or irregularly occurring familial illness due to changes in the motility of the large intestine. According to the literature we are confronted with this affliction in approximately 30% to 60% of all gastrointestinal troubles. The colic pains of the nursing infant and constipation in the young child also belong here though we are more familiar with the problem in young adults. It occurs more frequently in women than in men.
The diagnosis, for which the history is most important, is based on the following symptoms:
(1) Pain mostly on the left side and sometimes on the right side low in the abdomen, of a character ranging from gnawing to nagging, radiating out to the back or chest. There are pain-free periods.
(2) Frequent production of small quantities of feces that are of variable consistency; large quantities of gas. After defecation and release of flatulence the pain decreases or even ceases. The pain increases again in consequence of a meal or emotional stress.
(3) Little or no feeling of illness or loss of weight, etc.
(4) Often occurs with another psychosomatic symptom such as premenstrual complaints, tension headaches or hypoglycemia.
(5) Mood usually depressive.
Physical investigation reveals the patient to be in remarkably good condition. The abdomen is sometimes diffusely swollen; percussion gives a tympanitic tone. In the painful region the bowel is swollen in a sausage-like shape, mobile relative to the under layer. The abdominal wall often feels cold to the touch above the spastic section of the bowel.
This problem demands a thorough investigation be made into the quality of the stools.(2) The indigestible fiber proves to play an important part in this.
The proportion of fiber in food has fallen drastically in this century. Over a hundred years ago about 600gm of bread was consumed per head of population; at the present day it is barely 200gm. In addition to this it must be pointed out that nowadays we are dealing with highly refined flour, i.e. flour with the fiber removed, as a result of which the fat and sugar content of our food has risen from 15-20% in earlier times to 55-60%. Hence the modern diet contains very little fiber.
This fiber is important. The more fiber present in the food, the faster the chyme is passed through the intestine. With an increase in fiber, the quantity of feces also increases. It has been found that primitive peoples produce three times as much stools as Europeans. It has also been found, connected with this, that problems such as constipation, diverticulosis of the colon, cancer of the rectum, hypercholesterolemia, appendicitis and gall-bladder troubles are significantly less frequent among these peoples or even do not occur at all.
In summary, there seems to be a connection between our culture (or diet) and a number of bowel disorders, including spastic colon. The advice in a case of spastic colon is to increase the proportion of fiber in the diet. The question remains whether this will entirely solve the problem.
The colon is a large, hollow organ that garlands the rest of the digestive tract (stomach, duodenum, small intestine). It is about 1.5 meters long. Its wall contains (as does that of the small intestine) longitudinal and circular muscles, but those of the colon (in contrast to those of the small intestine) are arranged in three bands (taeniae coli).
The colon is divided into three parts - the ascending, the transverse and descending in that order - going from the end of the small intestine (the ileum) to the sigmoid, situated before the anus.
It is striking that in its journey through the abdomen the colon closely approaches almost all the organs of importance for metabolism in the following order: right ovary, liver and gall-bladder, right kidney, pancreas, stomach, spleen, left kidney, left ovary.
The colon ends in the anus, which can be consciously relaxed and contracted. In the whole digestive tract this is only found elsewhere in the mouth: we can affect the digestive flow by conscious effort only at the beginning and the end.
The large intestine has no peristalsis, unlike the small intestine.(3) The are two kinds of contractions:
(1) Mass contractions/ where a large section of the bowel contracts, and the portion situated distally from this relaxes. These contractions shift slowly (1cm per second). They occur a few times a day.
(2) Haustrating contractions, which have a mixing and kneading effect but only extend over a small area and can last several tens of seconds.
The colon is an easily-irritated organ that reacts to all kinds of substances such as gastrin and cholecystokinin, which are responsible for the gastrocolic reflex, to substance P and enkephalins, which increase motility, and to glucagon and secretin, which act to reduce motility. Apart from this it is interesting that very little is known about the movements of the large intestine, especially in connection with the sympathetic and parasympathetic nervous systems, which are present in such abundance in the bowel wall, and the relationship between the feces and the movements of the bowel.
Steiner(4) points out that a relationship exists between the development of the colon in successive kinds of animals, in terms of their stage of development, and the development of the forebrain. The study of the various metabolisms reveals that it is only with the coming of warm-blooded animals that such a thing as a colon comes into existence; that the more highly developed the animal is the longer the colon; and that particularly the ruminants develop an enormous cecum, which in man finally achieves "normal" proportions - the appendix is, in fact, a shrunken cecum. It is further of interest that the colon "grows into" the body from its distal end (the anus) towards its dorsal end. Finally, let us remember that in the course of development the place where the ileum connects with the colon has become displaced: in the most highly developed creatures the ileum empties into the colon from the side through the ileocecal valve (valvulae Bauhini).
When one looks at the large intestines of the various creatures side by side, then the human colon looks the most harmonious. It is as though the organ has found its ultimate destination in man.
The colon has no peristalsis, which indicates a lesser influence from the etheric body than one observes in the small intestine. The continuous firming up of the faecal flow also tells us this. What we have here is a hollow organ that is very sensitive to stimuli. The bowel wall contains a great deal of vegetative nerve tissue, and the bowel itself can be consciously closed at its end. These are features that suggest a powerful influence from the astral body and ego-organization respectively. Just think, for example, of the significance in child development of the child's learning to hold back its stools. The child could not be prouder (more aware of its growing ego)! The relationship with warm-bloodedness (where is the body temperature most accurately measured?), the occurrence of intensified movements of the colon associated with emotions or biographical problems, and the dependence on cultural influences with regard to the product, reinforce the feeling that what we have here is a sense organ rather than a constructive metabolic organ.
Life can continue normally without a colon. A number of years ago there were over 70,000 stoma-patients without a colon in West Germany. The more highly developed an organ is, i.e. the more spiritual its function in the body, the more easily one can do without it in whole or in part. Compare Steiner's observations on the spleen.(5)
In summary, the colon is an organ that, although it belongs to the metabolism, shows a high level of ego and astral activity and above all seems to have an observing function. So what does it observe? m order to answer this question it is necessary to understand something of the metabolism as such.
Rudolf Steiner's Occult Physiology, however difficult and inscrutable, is a good key to understanding the metabolism. The central theme in this work is the "preparation" of the blood as ultimate bearer and instrument of the ego. All organs contribute something to it, and this whole process of preparation may be called "metabolism".
Food undergoes a long journey of digestion from outside to inside, which is marked by a number of confrontations. Steiner speaks of "aussere Regsamkeiten" and uses the example of stubbing a toe on a table leg, which gives rise to two processes, one directed outwards and the other directed inwards. Outwardly the table leg (and the same would be true of a portion of food or a sense impression) is pushed away, overridden, excreted (Absonderung). Inwardly consciousness arises of the pushed-away object (the external world and all it embraces) and of one's own person: my toe hurts, and I have only become aware of it by stubbing it. Steiner speaks in this connection of the "Emahrungsstrom" (nutritional flow). The pushing away is not complete because then the pushed-away object could not have been noticed and remembered; the table leg as it were comes a little into us. One develops one's inner world in response to the world outside. After stubbing one's toe a few times one learns that one must be careful in the dark because one has built up an internal notion of table legs. It is the same with food: one digests sugars in order to construct sugars inwardly. In this the organs play an important role. The organs are little bits of internalized external world and can be seen as the serving-hatches of cosmic, planetary forces. Thus the kidneys are linked with Venus, the spleen with Saturn, etc.
This is how man with his blood-in-the-making figures between two external worlds: the physical, visible world which has become earth and which man confronts with matter or substances (what the matter looks like, what form it has), and the invisible world of the planets that enables him to see which formative forces the substances originate from. The former world comes to us through food, breathing and the senses; the latter world through the organs, the access-gates of the world of the planets.
If the blood (the human being, the ego) is to be formed in the right way, a concept must be formed of the best way to achieve that. This can be compared to making a cupboard: what kind of wood, what methods of joining the components, what hinges and fastenings, what shape shall I give it? Substance (Latin for "what stands underneath") and form are the elements which, brought into an individual combination by the ego, make the blood into our own personal blood as the center of our personality. Every foodstuff contains, for example, carbohydrates (material aspect), but in different foodstuffs these carbohydrates take on a different appearance.(6)
In the process of breaking down, of observing, the ego, astral body and etheric body take control of this in such a way that in the external world, viz. the bowel cavity, the material and formal aspects of the foodstuff disappear, and its physical remains are removed (Absonderung), while at the same time an inward awareness of the material and formal aspects of a carbohydrate comes into being, which must contribute to the building up of one's own (blood-)sugar (Emaehrung). The ego continues to play a mediating, regulating and identifying role throughout.
The process which takes place in the vicinity of the bowel wall could be described as transsubstantiation. This process continues from the mouth to approximately the ileocecal valve, during which time the contents of the alimentary tract undergo a constantly increasing process of breaking down or destruction. Into the cecum comes an amorphous mass of material, which in many animals then leaves the body since there is nothing more to be got from it. In the human body and that of other highly developed animals it then goes on to receive its maximal form before the exhausted material finally leaves the body as feces.
In order to understand the function of the colon one may think in terms of two gestures in the intestinal tract. The first gesture is visible in the descending flow of ingested food, which gradually (and, for the ego, productively) loses its outward form and turns into lifeless matter. This is the observing gesture. The other gesture, directed more towards construction, is expressed in the acquisition of form by the fecal mass, which is maximally observable in the sigmoid and is less and less apparent as one looks higher and higher up in the bowel cavity. This form belongs not to the material but to ourselves as the originators of this form. In this way two formative processes flow contrary to one another: from above the external formative process belonging to the external world and fading away as it moves lower, and from below the formative process that comes outwards from within and is caused by what: the ego or the organs?
That we have two gestures is apparent from, among other things, the two movements of the colon described above: a steady, more or less peristaltic movement which conveys the exhausted matter to the exit, and an antiperistaltic, haustrating gesture that brings the material flow to a halt and, as it were, kneads it and so gives it a definite form.
In this way the colon makes visible what sort of formative processes are taking place in the body, how the body offers resistance to formative processes from the outside, and how it can express itself in matter.
But does one need such a long colon for this purpose? It is interesting to look again at the location of the colon and to realize that there are three parts to be distinguished: the ascending, transverse and descending portions. One could, in a somewhat associative way, say that the ascending portion, in which the fecal flow is upward (towards the liver) corresponds to the effective area of the etheric body, that the transverse portion, extending between the kidneys, has to do with the astral body (think also of all the other organs that the colon passes here), and that the descending portion from the spleen onwards, in which the feces assume their final form and are "shown" to the external world, lies in the effective area of the ego. In this way the formative capacity of the human being at the levels of etheric body, astral body and ego-organization would become visible and hence observable in the corresponding parts of the colon respectively.
When we look at the feces we can also distinguish a material aspect and a formal aspect: (a) how well can we break down (catabolize) and (b) how well can we build up (anabolize)?
In (a) the occurrence of a lot of gas in the intestines and/or the finding of undigested remains of food in the stools indicates an inadequate breaking down or observation of the external world. Gas in particular indicates an excess of uncommitted astrality not brought under the control of the ego.
In (b) cramps, diarrhea and constipation indicate disturbed forming pro-cesses. "Kraempfe zeigen die Unmoeglichkeit dass Ich-Organisation und Astralldb in physischen und Aetherleib hineinfahren"(7) (Cramps are a sign that the ego- organization and astral body cannot penetrate the physical and etheric bodies).
It can be seen from the feces how well the human being is able to manage earthly reality in such a way that it leads to the building up of one's own inner reality. Always valid: the better the destruction the better the construction.
What is here described for the ego vis-a-vis the physical would also be valid for the astral vis-a-vis the etheric. In this connection Steiner mentions colon and bladder in the same breath.(4)
That there is "a lot of ego" in the feces is also expressed in the reply that Steiner gives to a question about the wisdom of using human manure in agriculture.(8) Steiner advises that no more should be used than what the farmer and his family produce. There is too much "ego" in the feces for one to be able to make excessive use of it; this applies not at all, or much less, to animal dung which bears an imprint not so much of the earthly and individual as of the cosmic and astral.
It would seem that the large intestine is a sense organ that is intended for the observation of how far the human ego is capable of manifesting itself in the metabolism, which shows an interplay of construction and destruction that must lead to the blood formation which is the ultimate expression of the ego in the physical. With this we can make a transition to the pathology, where the question arises as to why someone cannot express himself in keeping with his potentialities, his biographical mainsprings, etc.
On the basis of the above we can now understand what is the matter with a person with a spastic colon. There are three possibilities, which may occur separately or in combination in one and the same person:
(1) There is something wrong with the destruction flow
(2) There is something wrong with the construction flow
(3) There is something wrong with both
The correct form is not being produced due to too much or too little observation, or ditto construction, or (as an expression of a general ego- weakness) an inability to synthesize. The relationship to the external world is experienced too emotionally; the astral body is stronger than the ego- organization in observing and constructing. The person who cannot manifest himself fully feels himself over-addressed or rushed off his feet by the external world. His body, his psychic circumstances or the social climate do not allow him enough space to manifest himself in his full individuality. As a reaction to this, the person gets trapped either in too much construction, a desperate need to do everything without enough substance or careful thought (diarrhea) or else in too much destruction, endlessly analyzing and working things out analytically before he finally gets down to actually doing something (constipation).
The situation described - not being able to achieve one's own form for one's own existence - can have various causes:
(1) Constitutional. Here, the organs come into the picture. It is interesting to look into the question of which constitutions are most associated with spastic colon. An important role is probably played by the spleen, the liver, the lungs and the kidneys.
(2) Diet. The importance of fiber has already been mentioned. Note that fibers are polysaccharides, which underlines once again the role played in the spastic colon problem by the ego "Wo Zucker ist, ist Ego-organisation..." (Where there is sugar there is ego organization...). Fiber forms an "aussere Regsamkeit" of the first order.
(3) Biographical. This involves mainly young adults where it is, of course, a matter of ego birth. But later situations in life where a powerful manifestation of the personality is required can also give rise to a spastic colon. The relationship with other psychosomatic illnesses is also seen here.
It is remarkable how little advice on therapy for problems of the large intestine is to be found in anthroposophical medical literature. It would seem that in the period when Steiner saw patients with Ita Wegman there was nobody walking around with a spastic colon. There are a few patients whose problems are not far removed from this one,(9) although these are mainly in connection with Carpellum mali (see below). Nor has much been written on the subject subsequently. Husemann suggests only a few remedies, having first specifically mentioned "psychiscne Fuehrung" (psychological guidance).(10)
During therapy it is important first and foremost to build a picture of the problem with the patient and to check whether he recognizes anything of his own situation in it. Our account of the problem as given above is based on numerous occasions when we have discussed the formation problem with patients. It is essential to help these always rather tense people to begin to see things in perspective. If the tenseness, the feeling - for whatever reason - that they cannot assert their individuality is deeply entrenched, some form of psychotherapy is always necessary.
It is a matter of learning to see things in perspective ("I'm actually only an ordinary person") and to be objective ("What can I do?" instead of "What is expected of me?"). I often advise the patient to take a kind of retrospective look at the end of each day on the theme, "When have I really been myself today?"
A supportive role in this growth process of the ego in the face of massive astrality is offered by artistic therapy, especially clay-modeling and curative eurythmy. Sounds such as R, M, N, B, I and A and above all the "seelische Uebungen" (spiritual exercises) are very effective.
Regarding medication, there are all kinds of possibilities. Directly working antispasmodics are Nicotiana, Chamomilla, Carbo and Cuprum. Mercurius in one form or another is often effective. When one has clear ideas about which organs are having a disruptive effect, one naturally directs one's medicinal therapy in that direction, supplementing what one is already doing with the above-mentioned Cuprum. Apis, Aurum and Stibium are particularly ego-strengthening, as is the prescription of a fiber-rich vegetarian diet. It will sometimes happen that a too sudden and rigorous change of diet brings on a depression. This can then be used as a point of departure for subsequent therapy.
Excessively cerebral types must be made to take up something physical such as walking, cycling or swimming, though without feeling that they have to achieve great things.
The Remedy - Carpellum mali
A remedy with which I have recently been working on the advice of Machteld Huber (personal communication) is Carpellum mali, viz. applecore. Steiner advises this for a hypochondriac, melancholy woman of 37 who is afraid of becoming pregnant again and complains of "dauemden Druck der sie allesfalsch anfassen lasst" (a constant pressure which always makes her go about things in the wrong way).(9) Here we can recognize much of the patient with a spastic colon. She has in the past suffered from constipation. Steiner says that the bowel and especially the colon is too narrow (haustration, ileus?). Carpellum mali is "zusammengeflickt" (patched together) with Juglans regia, the walnut. These are imitations of the astral body of the large intestine and the lungs respectively. Steiner relates depression and bowel problems, which may at the same time have been responsible for the (earlier?) difficult pregnancy.
In cases described elsewhere,(11) Carpellum mali is used in the treatment of patients with sub-ileus accompanied by diarrhea or constipation and a tendency to depression or melancholy. These case-studies also involve diverticulosis coli.
It would seem worthwhile to gain experience of the remedy (Carpellum mali comp. Weleda) in a wider context. My initial experiences are encouraging, to say the least. It is certainly necessary to formulate a clear list of indications.
Aart van der Stel, M.D.,
1 Bartelink A. (1977) NTVG 121(38):1462 ff.
2 Burkitt P. et al. (1972) Lancet, 30 Dec., p.1408 ff.
3 Smout A.J.P.M. et al. Bewgingen van het maagdarmkanaal. (1991) Tilburg
4 Steiner R. Geisteswissenschaft und Medizin. (1961) Domach, p.93 ff.
5 Ditto. Eine okkulte Physiologic. (1971) Domach.
6 Hauschka R. Emahrungslehre. (1970) Frankfurt am Main.
7 Steiner R. Heilpedagogische Kurs, Domach.
8 Steiner R. Landbouwcursus.
9 Degenaar A.G. Krankheitsfaelle, Stuttgart.
10 Husemann et al. DBS Bild des Menschen als Grundlage der Heilkunst. (1978) Stuttgart. Vol.11, pt.2.
11 Beitraege zu einer Erweiterung der Heilkunst. (1961). 4:162 ff.